Exposure Anxiety is one of

the three faces of “Autism”

Notes from a presentation by Donna Williams

At Flinders University, Friday Jan 16th 2004

œ Exposure Anxiety (being indirectly confrontational)

œ The system of Sensing versus that of interpretation
œ Problems of Connection (being mono and delayed processing)
A large part of the ’disability’ aspect of ’autism’ is often not these faces themselves but
secondary problems such as, ' self abuse','phobia' ,'ritual’ obsession'and 'disturbance'
.
Most of these things are caused by the confusion, frustration and isolation of the
condition itself, but some of these problems are not about the condition, they are
about THE LACK OF FIT BETWEEN ONE’S OWN SYSTEM AND THAT OF
THE WORLD... in other words, managing some of these problems is partially a
matter of being the ' language of behavior'

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 An Example of that clash
Autistic’

Reliant on the mapping of pattern/theme/feel known as ’Sensing’, with intermittent use

of interpretative processing at the level of the literal

Mono tracked processing with moderate to severe information processing delay.

Indirectly Confrontational, self in relation to self

Asperger’s’
Interpretative processing at the level of the literal )sdtlt intermittent processing
beyong the literal to the ’significant’,

Generally Mono tracked processing with mild information processing delay.

Those with Exposure Anxiety are indirectly-confrontational and self in relation to

self. Others are able to manage directly confrontational other-initiated social
interaction but generally lack a simultaneous sense of self and other.

Neurotypical

Interpretative processing beyond the literal to processing for personal and relative
significance.

Generally Multi-track processing with only occasional incidents of processing delay.

Generally enjoy, even seek, a directly confrontational, other-initiated social

emotional reality. Generally able to maintain a simultaneous sense of self and other.

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 Exposure Anxiety
Exposure Anxiety is an involuntary self protection mechanism underlying compulsive
avoidance, diversion, retaliation responses.

It makes it difficult to dare ’expressive volume’ in a directly confrontational (self in

relation to other) world whose culture is geared toward making you notice you have
noticed: something they call communicating, sharing, interacting.

Exposure Anxiety can heighten the suffocating sense of your own existence so that it
feels TOO CLOSE UP, too in your own face., so
it causes you to have an instinctual involuntary aversion to conscious
awareness/responsibility for your own expression.

Like conditions like agoraphobia, Exposure Anxiety can escalate to make

increasingly hard to stay motivated to initiate speaking, looking, to express a
need or want, to share an interest or even dare to stay aware you have one.

It can create such an emotional obstacle to connection to mind and/or body that the
person develops islands of expression in which they can’t do for themselves, can’t
do as themselves, or can’t do by themselves.

Pushing beyond the limits of will’s tolerance, Exposure Anxiety heightens and can
result in island’s ofinvoluntary aversion, diversion and retaliation responses.

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 Exposure anxiety in the general population

Exposure anxiety effects all of us. Think back to your teens when your hormones
got out of control and it affected your behaviour. This happens to people with autism
too. The difference is that their Exposure Anxiety gets worse under these conditions
whereas for most neurotypical people this state is something quite new. We all have
known a height of excruciating selfconsciousness that compels us to pull away, divert
attention. retaliate as though we would otherwise suffocate. What worked in getting
through to you in that state? What didn"t work? Everything that occurs in ’autism’
occurs in those who are not autistic. The difference is degree and frequency.

Degree and frequency of attacks of exposure anxiety affect EVERYTHING . It

affects how we appear, how we experience the world, how we experience ourselves
and it affects how our personality, language, behavior and social-emotional skills
develop through adaptations within our prison and between the spaces made by the
bars.

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 Exposure anxiety
Causes and consequences.
Exposure Anxiety is a natural social -emotional consequence of living in the system
of sensing and we all started there.

Exposure Anxiety is a normal self-protective survival response to a feeling of

invasiveness and overload.

Neurotypical people are able to consistently keep up with the rate of incoming
information, having the processing time to make cohesive meaning out of incoming
information, going beyond the sensory mapping of that information, to the
categorization and literal interpretation of it and then beyond that to processing the
information for relative and personal significance. Neurotypical people are so able to
keep up with that rate of incoming information, not because they are more clever than
people with autism, or Asperger’s, but because they take n LESS information so
they have more time to process it. The non-autistic person FILTERS incoming
information so they take in less information at a time.

Because the neurotypical person can keep up with the rate of incoming information,
information doesn’t feel like an invasion. Incoming information generally doesn’t
trigger survival responses like Exposure Anxiety. The result is that neurotypical
people learn to WANT MORE INFORMATION and MORE INVOLVEMENT that
brings this information. The neurotypical person appears to have ’learned’ more, even
if the ’autistic’ person has taken more in and appears consciously and under test
conditions to have ’learned’ less.

Children with untreated bipolar in acute manic states (also common in children with
undiagnosed Tourette’s) are more subject to sensory flooding and their higher levels
of Norepinephrine make them more susceptible to develop chronic fight-flight states
such as Exposure Anxiety. When these reactions are a daily occurrence this can easily
become part of one’s view of oneself and the world- in other words it begins to affect
the development of personality and identity. Avoidant Personality Disorder is the
depressive equivalent of this defensive state and can occur in children who can appear
passive, even compliant. It can co-occur in some with childhood bipolar, can be
confused for Exposure Anxiety and to some degree responds to some shared
interventions.

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THE IMPACT ON HEALTH AND INFORMATION PROCESSING
Severe chronic anxiety is known to exacerbate inflammatory conditions, to reduce
stomach acid necessary to digestion and to suppress gut immunity with subsequent
effects on enzyme production. Leaky gut, immune deficiency and the inflammatory
effects on gut, liver and pancreas function as well as on the blood brain barrier are
thought by some to be responsible for the information processing and sensory
perceptual problems seen in ’autism-spectrum’ conditions. Whilst not all of these cases
have chronic Exposure Anxiety a great many do.

THE IMPACT ON IDENTITY

The avoidance, diversion, retaliation responses of Exposure Anxiety as well as
the fearsome experience of emotional overload of adrenaline highs with their effects
on excruciating sensory heightening and self injury, progressively not only affect
relationships to others, to the world and interfere with concepts such as sharing,
caring, and love, but most essentially, they affect identity and one’s relationship to
body, and sense of self. Working with Exposure Anxiety means working toward a
healthy restructuring of identity.

THE ROLE OF PERCEIVED ’JUSTIFICATION’ IN

REINFORCING AND PERPETUATING EXPOSURE ANXIETY
RESPONSES.
In an adrenaline-addicted state, staying calm is not a long lived option, and however
much the self may feel happy to stay there, the compulsion to provoke an adrenaline
high is not voluntary and as soon as one relaxes, the temporarily redundant Exposure
Anxiety mechanism begins to go through withdrawal. It can compel the self toward
an adrenaline provoking behavior in which pleasure turns to bliss and mania and
ultimately into emotional overload, phobia and blind panic. The drug like call of the
impending adrenaline rush means that the only way for the self to control this see
saw, is to avoid any uncontrollable road to emotional stimulation. On the other hand,
attempts by the environment to ’invade’ through sharing, communicating, caring or
being subject to information overload, can be taken as justification to employ the
adrenaline-driven self protection responses of avoidance, diversion, retaliation and in
the process reinforce Exposure Anxiety’s important and valued role as internal,
parent, teacher, protector and prison warden of the invisible cage which in turns, is
both the prison and the sanctuary. Like any constant bullying driving force,
eventually it becomes easier and less tiring to side with it than to fight it.

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 UNDERMINING EXPOSURE ANXIETY
1 ) Address dairy/gluten intolerance as a result of impaired gut/iminune function- Dairy /gluten
intolerance is not dairy /gluten allergy and may not show up in allergy- testing. My own experience is
that dairy/gluten intolerance causes what are described as opiate-like effects and when these levels go
down, this causes the kind of withdrawal, distress
and agitation you might see in a drug addict coming of drugs. Only by getting off this see saw. does the
system have a chance to stabilise. 80% of people on the spectrum have been found to be dairy/gluten
intolerant (Shattock).
2) Address inherited salicylate or phenylalanine intolerances Salicylate intolerance is believed to
affect around 60% of people on the autism-spectrum (Waring) and is associated with the inflammatory
states which are exacerbated by chronic stress and affects the gut lining as well as the permeability of
the blood brain barrier. In my case Salicylate intolerance causes cocaine like highs with obvious
consequences for reinforcing Exposure Anxiety responses. Phenylalanine is a problem for people with
PKU for which there has been widespread testing since the mid 1960’s, the mild and transient forms of
which can sometimes still go undiagnosed or untreated. Inability to properly metabolise phenylalanine
when left untreated is known to be associated with agoraphobia, self injury, acute anxiety and social
phobia.
3) Chronic stress is associated with lowered immunity and 20% of people on the spectrum are known
to have low or no secretory (salivary) IgA (Gupta), the immunoglobulin necessary to alert the immune
system to invaders or properly respond to bugs and without IgA proteins are also not properly
recognised., exacerbating gut problems and the consequences this has for information processing. Lack
of secretory IgA is associated with chronic ear/nose/throat infections. Soya is believed to decrease
levels of gut IgA, leaving the gut more susceptible to harmful gut bacteria.
4) The opportunistic fungal infection of Candida thrives in alkaline producing states of high stress,
lowered immunity and inflammation. Sugar feeds this fungal infection and with insufficient secretory
IgA it can do what it likes with the body. Sugar lowers magnesium levels - the anti-anxiety; mineral,
increasing the force of this cycle. Candida exhausts blood sugar levels, causing mood swings and
triggereing hypoglycemic episodes which feed sugar craving. When it exhausts the sugar supply it uses
up the bodies vitamin B,. reducing the person’s ability to keep up with incoming information and cope
with stress.
5) Digestive, immune system and toxicity problems generally mean the majority of people on the
autism-spectrum are deficient in a lot of nutrients. particularly, the B vitamins. magnesium. zinc,
vitamins A and E, amino acids and fatty acids as well as the good bacteria (probiotics) necessary for
digestion. Supplementing these can mean the difference between information overload justifying
Exposure Anxiety or not, nutrient deficiencies can also exacerbate epilepsy.
6) 70 % of incoming information is visual. Fluorescent lighting increases visual overload and its
impact on visual fragmentation in people who struggle to keep up with incoming information.
Affordable lenses from BPI cost around $65 a pair and have helped many people on the spectrum by
cutting out certain light frequencies in order to maximise the processing of what' s left. Similarly
techniques which cut down information processing time such as slowing down the pace and quantity of
speech, keeping language visual and concrete through techniques like -' speaking via objects'or gestural
signing and approaching monotracked people. in a monotracked way can also help reduce Exposure
Anxiety through decreasing information overload.
7) Bringing in an indirectly confrontational approach is essential in undermining the process by which
the self progressively identifies with and sides with Exposure Anxiety. An indirectly confrontational
approach involves A) doing as though for oneself, being self owning, being self in relation to self,
modelling rather than teaching, being ' fly on the wall'and '
incidental' . B) keeping things in small doses,
playing hard to get, always leaving the person wanting more, using triggering techniques rather than
those relying on accessing, leaving the endings off to stimulate a sense of ' want'C) speaking via
objects, addressing the object/issue rather than the person, referring in the third person. speaking out
loud to oneself. D) using an indirectly confrontational approach in anything you wish to promote and a
directly, confrontational one focussing on that which you wish to inhibit (a similar approach is often
used with naughty teenagers).
8) Medication where bipolar, Tourette' s or OCD chronically raise Norepinephrine levels, exacerbating
the chronic fight/flight responses of Exposure Anxiety. Addressing Anxiety/Depression in those with
Avoidant Personality Disorder may be similarly helpful.

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 Building want, countering anti-motivations,
undermining identification with exposure anxiety

Can’t do it for myself, can’t do it as myself

can’t do it by myself

* puppets, * drama, * talking via objects,

* using put-on voices, * ’shadowing’ and ’fading’, * facilitated expression,
* flower remedies * discovery learning

A matter of expressive volume

* turning down the ’volume’ of your ’directness’, decreases the sense of ’audience’ that
triggers and raises exposure anxiety so lowering the ’volume’ of Your ’directness’ can
help them turn up the ’volume’ of theirs.

* flower remedies to help parents manage their own emotions and promote the
determined caring detachment needed to hold back with people with exposure
anxiety.

Aversion, diversion, retaliation responses as language

* Where yes=no and no=yes, ignoring or rejecting unwanted behavlor will not work
and will often reward the person with adrenaline high and reinforce the Exposure
Anxiety responses. I use. ’yes but’... type strategy, employing phrases like. "gentle
biting", “soft slapping", "quiet screaming". Social encouragement is generally an
inhibitor with severe Exposure Anxiety and decreases the reward one gets from the
reassurance of social distance between the world and one' s own world.

* Hypnotherapy style story telling through objects can be done in small, play hard to
get doses as though for the teller'
s OWN BENEFIT as an indirectly-confrontational
form of counselling and can help model self calming strategies and confront the
difference between selfhood and Exposure Anxiety responses.

* Addressing the issue/object rather than the person, speaking in the third person or
via characters reduces justification to fight against sensed '
invasion'
.

* Do as though FOR OWN BENEFIT, not as though for the person with '
autism'
-
BE SELF DIRECTED in your actions. * '
Model' , don'
t'teach'.

Play hard to get, small doses, LEAVE THE PERSON WANTING MORE- build
identification with '
want'
, remember compliance is not ' want'and can hide a passive
resentment in which the person will not use such actions independently without
prompt.

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 OTHER DEVELOPMENT PROGRAMS
Promoting connection to physical/emotional sensation:

* reflexology, * cranio-sacral therapy, * body brushing,

* hair brushing, * massage, * deep pressure
* ’hypnotherapy’ * storytelling via video’ * body as pot-plant
* obstacle courses
* the use of color * music * aromatherapy,
* relating via objects * Bach Flower remedies

Promoting Letting go control:

* tickling, * Trampolining * horse riding,

* running, * swimming * stomping
* shouting room * throwing box * Hypnotherapy stories
* Bach Flower remedies

For developing tolerance to the audience of oneself.

* mirrors * talk back toys * typing,

* facilitated expression * Bach Flower remedies
* Hypnotherapy stories

For developing tolerance of connection with others:

* connection through objects as symbols

* talking through objects * people as ’statues’ * creative movement,
* music therapy * mirrors * art therapy
* hypnotherapy stories * meeting through patterns
* the use of an indirectly confrontational approach.
* flower remedies

Learning calmness:
* dietary interventions
* breathing techniques
* rhythm, rocking, Jumping as self calming techniques.
* replacing Caffeine
* music
* vibration
* Small doses of appropriate medication in some cases.

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 In a nutshell
However narrowly Autism was once defined, it is now well known that there is no
one type of ‘autism’. Exposure Anxiety is one face of autism and therefore also in
those who moved out of the autistic range into interpretative information processing
and that category now called Asperger' s Syndrome.

Exposure Anxiety is a relativelv treatable physiological condition which can be

shaped by the way the environment compounds, works with, challenges or expands
the condition, on a physical, environmental and interpersonal level.

Exposure Anxiety is shaped too by personality differences and forces which alter how
we identify with or rebel against the condition. In my view one of the biggest
advantages a child with Exposure Anxiety cain have is an environment which self-
owningly models eccentricity, humor, and the surreal and which accommodates the
freedom of undirected discovery. So if yeu' ve forgotten how, then get having fun
FOR YOUR OWN BENEFIT. Seizing life for yourself is one of the most inspiring
things you can model when living with a control freak.

Whilst the descriptions given here of Exposure Anxiety may describe a system which
may be similar for so many people, the adaptations to those systems will vary
enormously. So whilst some answers may apply to many, other answers need to be
tailored to the individual. That can' t be found in a book. The person with Exposure
Anxiety is your book. Work with what they present as a whole person, the
physiology, the behavioral and developmental issues but also, so importantly, the
person beyond the bars of their invisible cage. Listen to the language of their behavior
yet look beyond it, to what appears within the cracks which speaks of the self beyond
the confines of the condition. Be imaginative, eccentric, surreal. Don' t be held to
emotional blackmail. Don' t be intimidated. Don' t be dominated. Be challenging yet be
respectful and don' t forget to breathe and laugh. Be bold in the face of your
limitations in understanding, yet be. humble enough to say, teach me.

Thanks for listening.

Donna Williams :-)

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 I AM THE BEAR
The day I was born
The prison warder watched over my shoulder
Waiting for a purpose
Waiting for the button
To be pressed.

Adrenaline filled my veins

The wallpaper ate me
The smell of shit filled my nostrils
The colors played in the frosted glass.
I was moved, too moved
By everything, too moved.

Then the big black nothingness.

In tidal waves with my clenched fists
And gnashing teeth
it claimed me.
My body no longer mine, but its body
The attacker was from within.
And I learned, progressively learned
That Exposure Anxiety was in charge.

It laid down laws against love, against emotion,

Avoidance, diversion, retaliation the language.
It sidled up to me and I called it parent.
It promised me leave in exchange for obedience.
I grew within the invisible cage, contorted.

I felt the light between the bars.

I heard my own torment and cared.
I played double agent and sold it out on every front.
Peering from my mountain top,... cautiously.
I am the bear.

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